chapter 1

The emergency room doctor barely peeked over her glasses when she looked up from her chart to ask “Do you have insurance?” This was not the question, no matter how inevitable it was, that I wanted to hear, no less answer right now.

“No.” I had applied for Blue Cross Blue Shield in my early 30’s and been denied for a medical history of substance abuse treatment. My argument for appeal was that I had 3 years of clean time but that was insufficient according to their criteria. They wanted 15 years. When I countered that 15 years later I would be in my late 40’s and too old to insure, they answered with the standard non-answer “That is our policy.”

I had made it to the age of 49 with no serious medical events. I knew my blood pressure was high, too high, OK, way too high, but I was exercising and dieting religiously to try and bring it down. That day I got a status update in the form of a Transient Ischemic Attack, or “mini-stroke.” I had lost the feeling in my right arm and part of my right side. I had always read that heart attacks were often foreshadowed by numbness in the left arm, so I waited for it to pass. Everything passes. Walk it off.

This one did not pass. I did not want to pay out of pocket for an ambulance, so I drove myself--one -armed--to the emergency room at St. Joseph’s Hospital in downtown Phoenix. I am used to driving old cars and trucks and begging/praying/pleading to just make this one last trip, this one last mile. This was the first time I had to make that entreaty to my own heart. I was admitted to the ER with blood pressure reading of 250/190.

Poverty often makes us do really stupid shit.

After the eternity that followed my “No” answer to the doctor’s insurance question, she removed her glasses and leaned in closer, with the body language of a loan shark’s semi-benevolent leg-breaker who tries to offer some comfort while sizing up your kneecaps. “This…” she said, using one finger to sweepingly point out the personnel and high-tech appointments of the ER, “will break you.” I did not doubt her. Instead, I was struck with the absolute certainty that the leading cause of second heart attacks was receiving the bill for the first one.

I still couldn’t process how this came to pass. I was in what was undoubtedly the best shape I have ever been in. I quit all the bad things! I converted my former heroin outlay into health food and supplements. I juiced, for Christ’s sake! I explained all of this to the ER doc;

“I don’t drink, do drugs or smoke. I don’t gamble or date women with names like Bambi, Lexus or Destiny. I lift weights three days a week, climb Camelback Mountain three days a week and bike on the seventh. I live on carrot juice and the blood of virgins. I only eat red meat once a week and I feel really, really guilty about it afterwards. There must be some mistake here.”

I was resigned to one of two outcomes; either a pedestrian death or an incomplete life saddled with crippling debt. My “woe is me” reverie was fortuitously interrupted by a nurse bringing me more pills. When she dropped one of them on the floor but did not pick it up, I asked “What no 5-second rule?” “Oh God no, definitely not in here” she said. When I looked down at the floor I saw what was quite possibly the most soul-crushingly, sub-industrial, faded pale green and maybe-used-to-be white linoleum that even a lifetime of acclimation to institutional chromatic deprivation left me wholly unprepared for. I also found my strength and salvation there, as the loudest voices in my chattering, cognitive choir, the angels of my baser nature said with unmistakable certainty;